Thursday, December 17, 2015

The Looming Credibility Trap of Obamacare?

While the young Disease Management Care Blog was first introduced to the concept of the "credibility gap" by Lyndon Johnson's Vietnam war, it wasn't until it started paying attention to blogs that it ran across the term "credibility trap." The former describes a disbelieving citizenry, while the latter describes a disbelieving government.

In the modern course of our Republic, there are 23 talented overachievers who nominally preside over a huge federal bureaucracy. The DMCB thinks of that as the core machinery that lies at the heart of the liberal promise that Big 21st Century Government Can Accomplish Great Things.

If the Politico article is correct, successive White House Administrations have marginalized the Secretaries, letting the majority of Washington DC run like some side-show perpetual motion machine. As the DMCB understands it, that leaves the White House to insource the management of the really important stuff, like getting reelected or reversing rising ocean levels.

And so it was when it came to the implementation of the Affordable Care Act. Looking past the partisan cacophony, it appears the White House genuinely counted on HHS to smoothly implement the health care marketplace and its various mandates. What happened was a fumble of historic proportions that will continue in the weeks and months to come.

While conservative pundits are using the Obamacare imbroglio as another tiresome I-told-you-so lesson in government overreach, the DMCB is worried that the bright men and women who are responsible for implementing health reform are getting a crash course in the cynicism of the credibility trap.

And as 2015 is threatened by death spirals, corrupted commercial enrollment data, unpleasant out-of-pocket surprises for consumers, small as well as large business market rate shocks, unpredictable legal challenges and further mischief by an emboldened Republican opposition, it becomes less a function of whose "fault" it is and more of a dreary exercise in keeping the Amtrak of health care from running off the rails.

The folks running the government bureaucracy are stuck with this lemon. Many are probably thinking that they deserve better.